Highlights
- •There is an inverse dose-dependent relationship between FTR and gestational age.
- •The dose-dependent relationship was consistent for both low- and high-risk procedures.
- •A lone infection point for FTR was identified at 31-32 weeks with cubic spline analysis.
Abstract
Background
The majority of failure to rescue (FTR), or death after a postoperative complication,
in pediatric surgery occurs among infants and neonates. The purpose of this study
is to evaluate the association between gestational age (GA) and FTR in infants and
neonates.
Methods
National cohort study of 46,452 patients < 1 year old within the National Surgical
Quality Improvement Program–Pediatric database who underwent inpatient surgery. Patients
were categorized as preterm neonates, term neonates, or infants. Neonates were stratified
based on GA. Surgical procedures were classified as low- (< 1% mortality) or high-risk
(≥ 1%). Multivariable logistic regression and cubic splines were used to evaluate
the association between GA and FTR.
Results
Preterm neonates had the highest FTR (28%) rates. Among neonates, FTR increased with
decreasing GA (≥ 37 weeks, 12%; 33–36 weeks, 15%; 29–32 weeks, 30%; 25–28 weeks 41%;
≤ 24 weeks, 57%). For both low- and high-risk procedures, FTR significantly (trend
test, p < 0.01) increased with decreasing GA. When stratifying preterm neonates by GA, all
GAs ≤ 28 weeks were associated with significantly higher odds of FTR for low- (OR
2.47, 95% CI [1.38–4.41]) and high-risk (OR 2.27, 95% CI [1.33–3.87]) procedures.
A lone inflection point for FTR was identified at 31–32 weeks with cubic spline analysis.
Conclusions
The dose-dependent relationship between decreasing GA and FTR as well as the FTR inflection
point noted at GA 31–32 weeks can be used by stakeholders in designing quality improvement
initiatives and directing perioperative care.
Level of evidence
Level IV, Retrospective cohort study
Keywords
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Article info
Publication history
Published online: November 06, 2021
Accepted:
October 25,
2021
Received in revised form:
October 15,
2021
Received:
September 22,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
